11 - Atherosclerosis - Clinical Manifestations

Question 1

when does the majority of coronary blood flow occur?

Answer 1

during diastole

Question 2

how can heart increase it’s O2 consumption?

Answer 2

increasing coronary blood flow

Question 3

coronary arteries arise from ___

Answer 3

sinuses of valvsalva at root of aorta

Question 4

major chemical mediator of increased coronary blood flow

Answer 4

adenosine (breakdown product of ATP)

Question 5

how does hypoperfusion / inc metabolic needs increase coronary blood flow?

Answer 5

anaerobic metab > local acidosis and lactate buildup > more adenosine > more CBF

Question 6

how much autonomic control over coronary blood flow is there?

Answer 6

relatively little - mostly just indirect

Question 7

how much does the heart rely on anaerobic metabolism under normal conditions?

Answer 7

virtually none - usually exclusively aerobic metabolism

Question 8

3 determinants of myocardial O2 demand (in order most>least important)

Answer 8

HR, wall tension, contractility

Question 9

surrogate measure for wall stress when estimating MV02

Answer 9

systolic BP

Question 10

key drug for reducing MVO2

Answer 10

beta blockers

Question 11

variant angina / Prinzmental’s angina

Answer 11

rare - resting chest discomfort w/ transient ST elevation due to coronary spasm

Question 12

4 classes of drugs that are good for CAD pts

Answer 12

beta blockers
nitrates
CaCBs
anti platelet drugs (ex aspirin)

Question 13

coated stents are better why, but what new disadvantage do they have

Answer 13

much lower rate of restenosing, but have a higher risk for late thrombosis

Question 14

what medications should be given for the first year after getting a coated stent

Answer 14

aspirin and clopidogrel to prevent platelet aggregation

Question 15

in diabetic pts, which is preferred - CABG or PCI?

Answer 15

CABG - more complete revascularization